Dignity factors - Privacy: Ideas you could use

Use an enuresis pad to maintain dignity despite incontinenceOpen

Incontinence can be a real threat to dignity. Using an enuresis pad, which issues an alert if someone is incontinent, can help save the embarrassment caused by staff ‘checking’ whether a person has been incontinent. It can also help identify patterns that make it easier to manage the incontinence.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by Hanover SmartChoice, a service that helps care providers assist older people and people with disabilities to maintain their independence and remain safely in their own homes.

When carers noticed that Mrs J, a resident of an Extra Care scheme, had become increasingly incontinent, the standard approach was for carers to enter her room at night and feel her bed to see if she had soiled herself. This was unsatisfactory for all. The solution was to use an enuresis pad, which issues an alert if Mrs J is incontinent. This allows for carers only to enter her room when an incident occurs, and if she is incontinent she is assisted with her toilet needs and bedclothes are changed straight away. It also enabled carers to examine records of alerts. They could see that a pattern of incontinence developed between 2 and 3 am. Using this information carers can now assist Mrs J to the toilet at 1.30 am and promote Mrs J’s continence.

Look at what people are wearing and how it affects their dignityOpen

Whether it’s a case of preserving modesty or enabling people to dress in clothes they like and feel comfortable wearing, consider how you could support people who use services to dress in a way that supports dignity.
This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice at Portsmouth Hospital NHS Trust, where it was noted that in the general ward areas, the hospital gowns were open-backed, with ties. Since the gowns were often used as temporary nightwear, mobile patients would frequently wear two gowns (one on backwards, to cover their back). In addition, the pyjamas supplied to patients were also often an undignified mismatch.

Replacement gowns and pyjamas were agreed with textile services and endorsed by the Patient Experience Council. A bid for funding was presented to the local Patient Environment Action Group and full funding secured from the League of Friends. The change of bedwear overcame a simple matter the Matron’s Essence of Care Group had identified, and enabled patients to regain a little more dignity at a vulnerable time.

Use ‘Do not disturb’ signs to respect people’s privacyOpen

To respect people’s privacy at certain times, you could consider introducing ‘Do not disturb’ signs.
This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by Sheffield Teaching Hospital NHS Trust. They use plastic reusable ‘Do not disturb’ signs which have been designed for curtains and doors. They have been found to be effective in reducing interruptions and are now being produced for use throughout the trust.

Provide single sex facilitiesOpen

Provide single sex facilities to avoid embarrassment or discomfort for people who use services.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice at Caterham Dene Community Hospital, which ensures that bay areas on the ward are never mixed sex. The majority of patients tend to be female, so the larger bays tend to be allocated to women, although there is flexibility in this arrangement if necessary. All bathroom and toilet facilities are designated as single sex.

Introduce an action plan to improve privacy and dignityOpen

Raise awareness of privacy and dignity – then use posters to remind staff about the simple actions that can make all the difference to people who use services. For example, ensuring uninterrupted bathtimes, keeping people covered at all times, and closing bedside curtains tightly.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by Doncaster and Bassetlaw Foundation NHS Trust, where the matron in Critical Care put together an action plan that included:

education forums to raise awareness of privacy and dignity; these were locally run departmental sessions attended by nurses, sisters and healthcare assistants.

posters displayed throughout the directorate with messages, for example, to promote bathtimes without interruption, to keep patients covered at all times and to close bedside curtains tightly.

'Do Not Enter signs for the curtains.

colour-coded clothes pegs to ensure curtains closed properly (these stay in each bed space to comply with infection control). Some areas have used a traffic light system, e.g. red peg = Do Not Enter.

The staff received feedback at departmental meetings and directorate audit meetings. As a result of this work patient privacy and dignity has improved, and staff awareness has been raised – the posters have made staff think about their actions and all staff are empowered to make sure 'Do Not Enter’ signs and pegs are used. The multi-disciplinary teams, including doctors, have taken this idea on board and always ask to enter behind curtains if they are drawn.

These actions have proven so effective that the initiative is now trust-wide, and good practice is shared via trust communication newsletters and the Essence of Care steering group.

asking people what they prefer to be called and documenting the answer

asking people at the start of care for their consent to share information

providing rooms for private conversations/interviews/phone calls

providing clear information – at the start of care – about quiet areas, privacy and confidentiality

encouraging staff to challenge others’ negative attitudes.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice at Manchester Mental Health and Social Care Trust, where the Older People’s Essence of Care team involves the whole multi-disciplinary team to make small improvements, which all disciplines and clinical services must follow. They have made all the improvements listed above and the team is evaluating these improvements and awaiting patient satisfaction results.

Enable people who use services to chooseOpen

Having the freedom to make choices enables people to feel they have power and control in their own lives. Look for ways to enable people to choose.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by a specialist care provider supporting Zoe, a woman in her late 40s with moderate learning disabilities and enduring mental health problems. Two-and-a-half years ago she lived in a small dwelling in general needs housing stock, with no personal effects to make it feel like home. The approach adopted by staff there was to control what Zoe could and could not do, and when. She displayed extremely aggressive and challenging behaviour, including destroying windows and furniture. She was frequently incontinent, apparently using incontinence to defy staff.

Staff did not want to work with Zoe and consequently a high level of agency staffing was used. Frequent incidents occurred, many of which were only reported verbally from one staff member to another. There were no plans in place to guide the staff as to how to manage the challenging behaviour, and recording was poor.
When Zoe moved to a two-bedroom semi-detached bungalow managed by a specialist provider, she was enabled to choose the furnishings and have personal effects around her. There is now a person-centred plan in place, with policies and procedures to guide staff, accurate recording and staff continuity. Zoe has much greater choice and control over what she does and when she does it.

The improved environment and staff practice has improved Zoe’s sense of well-being and independence. As a consequence, she is no longer incontinent and manifests far fewer, and less extreme aggressive and challenging outbursts.

Related document

Find out how you are doing on dignity and develop tools to promote improvementOpen

Measure how well your service is doing on privacy and dignity by asking people who use the service about their experience of it. With the information you gather you can identify areas for improvement. You can remind people about ways to improve by developing fact sheets or posters for staff and a charter to ensure the people using the service know what they can expect.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

Remind staff and visitors about privacy by putting door knockers on internal doorsOpen

In residential care, remind people about the personal space and privacy of individuals by putting door knockers on people's room doors. This can help to remind staff and visitors that they need to knock before entering.

This idea can be used in different settings - so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by Order of St John Care Trust. The door knockers give the impression that the bedrooms have their own front door, which visitors must knock before they enter. Care workers at the home have stated that having the door knockers on the doors really does make them think about gaining permission before they enter a room.